Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants

Markus A. Bendel; Travis O'Brien; Bryan C. Hoelzer; Timothy R. Deer; Thomas P. Pittelkow; Shrif Costandi; David R. Walega; Gerges Azer; Salim M. Hayek; Zhen Wang; Jason S. Eldrige; Wenchun Qu; Joshua M. Rosenow; Steven M. Falowski; Stephanie A. Neuman; Susan M. Moeschler; Catherine Wassef; Christopher Kim; Tariq Niazi; Taher Saifullah; Brian Yee; Chong Kim; Christine L. Oryhan; Daniel T. Warren; Imanuel Lerman; Ruben Mora; Michael Hanes; Thomas Simopoulos; Sanjiv Sharma; Chris Gilligan; Warren Grace; Timothy Ade; Nagy A. Mekhail; John P. Hunter; Daniel Choi; Deborah Y. Choi

doi:10.1111/ner.12636

Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants

Markus A. Bendel^*, Travis O'Brien, Bryan C. Hoelzer, Timothy R. Deer, Thomas P. Pittelkow, Shrif Costandi, David R. Walega, Gerges Azer, Salim M. Hayek, Zhen Wang, Jason S. Eldrige, Wenchun Qu, Joshua M. Rosenow, Steven M. Falowski, Stephanie A. Neuman, Susan M. Moeschler, Catherine Wassef, Christopher Kim, Tariq Niazi, Taher SaifullahBrian Yee, Chong Kim, Christine L. Oryhan, Daniel T. Warren, Imanuel Lerman, Ruben Mora, Michael Hanes, Thomas Simopoulos, Sanjiv Sharma, Chris Gilligan, Warren Grace, Timothy Ade, Nagy A. Mekhail, John P. Hunter, Daniel Choi, Deborah Y. Choi

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

49 Scopus citations

Abstract

Introduction: Surgical site infection is a potential complication of spinal cord stimulator (SCS) implantation. Current understanding of the epidemiology, diagnosis, and treatment of these infections is based largely on small clinical studies, many of which are outdated. Evidence-based guidelines for management of SCS-related infections thus rely instead on expert opinion, case reports, and case series. In this study, we aim to provide a large scale retrospective study of infection management techniques specifically for SCS implantation. Methods: A multicenter retrospective study of SCS implants performed over a seven-year period at 11 unique academic and non-academic institutions in the United States. All infections and related complications in this cohort were analyzed. Results: Within our study of 2737 SCS implant procedures, we identified all procedures complicated by infection (2.45%). Localized incisional pain and wound erythema were the most common presenting signs. Laboratory studies were performed in the majority of patients, but an imaging study was performed in less than half of these patients. The most common causative organism was Staphylococcus aureus and the IPG pocket was the most common site of an SCS-related infection. Explantation was ultimately performed in 52 of the 67 patients (77.6%). Non-explantation salvage therapy was attempted in 24 patients and was successful in resolving the infection in 15 patients without removal of SCS hardware components. Discussion: This study provides current data regarding SCS related infections, including incidence, diagnosis, and treatment.

Original language	English (US)
Pages (from-to)	553-557
Number of pages	5
Journal	Neuromodulation
Volume	20
Issue number	6
DOIs	https://doi.org/10.1111/ner.12636
State	Published - 2017

Funding

Conflict of Interest: Timothy Deer is a consultant for Axonics, Bioness, St. Jude Medical, Nevro Corp, Spinethera, Saluda, Flowonix, Jazz Pharmaceuticals. Dr. Deer held previous stock holdings in Nevro Corp and Spinal Modulation. He has current stock holdings (minor) with Axonics, Bioness, and Saluda. Dr. Deer receives funded Research from Mainstay Medical, Nevro Corp, and Abbott. Salim Hayek serves on the Medical Advisory Board for Boston Scientific. Imanuel Lerman has received investigator grants from Nevro Corp, Boston Scientific, and Electrocore. Thomas Simopoulos serves as a consultant for Boston Scientific, St. Jude Medical, and Nevro Corp. Steven Falowski serves as a consultant for Abbott, Medtronic, and Nevro Corp. Joshua Rosenow is a consultant for Boston Scientific. Nagy Mekhail was a medical monitor for the ACCURATE Study (Spinal Modulation) and the EVOKE Study (Saluda Medical). Dr. Mekhail serves as a consultant for StimWave, St. Jude Medical, and Saluda Medical. Dr. Mekhail receives research support from Mesoblast, Halyard, Inc., Mallinckrodt, Axsome, and Boston Scientific, Inc. All remaining authors have nothing to disclose.

Keywords

Complication
infection
spinal cord stimulation
treatment

ASJC Scopus subject areas

Neurology
Clinical Neurology
Anesthesiology and Pain Medicine

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10.1111/ner.12636

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Bendel, M. A., O'Brien, T., Hoelzer, B. C., Deer, T. R., Pittelkow, T. P., Costandi, S., Walega, D. R., Azer, G., Hayek, S. M., Wang, Z., Eldrige, J. S., Qu, W., Rosenow, J. M., Falowski, S. M., Neuman, S. A., Moeschler, S. M., Wassef, C., Kim, C., Niazi, T., ... Choi, D. Y. (2017). Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants. Neuromodulation, 20(6), 553-557. https://doi.org/10.1111/ner.12636

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title = "Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants",

abstract = "Introduction: Surgical site infection is a potential complication of spinal cord stimulator (SCS) implantation. Current understanding of the epidemiology, diagnosis, and treatment of these infections is based largely on small clinical studies, many of which are outdated. Evidence-based guidelines for management of SCS-related infections thus rely instead on expert opinion, case reports, and case series. In this study, we aim to provide a large scale retrospective study of infection management techniques specifically for SCS implantation. Methods: A multicenter retrospective study of SCS implants performed over a seven-year period at 11 unique academic and non-academic institutions in the United States. All infections and related complications in this cohort were analyzed. Results: Within our study of 2737 SCS implant procedures, we identified all procedures complicated by infection (2.45%). Localized incisional pain and wound erythema were the most common presenting signs. Laboratory studies were performed in the majority of patients, but an imaging study was performed in less than half of these patients. The most common causative organism was Staphylococcus aureus and the IPG pocket was the most common site of an SCS-related infection. Explantation was ultimately performed in 52 of the 67 patients (77.6%). Non-explantation salvage therapy was attempted in 24 patients and was successful in resolving the infection in 15 patients without removal of SCS hardware components. Discussion: This study provides current data regarding SCS related infections, including incidence, diagnosis, and treatment.",

keywords = "Complication, infection, spinal cord stimulation, treatment",

author = "Bendel, {Markus A.} and Travis O'Brien and Hoelzer, {Bryan C.} and Deer, {Timothy R.} and Pittelkow, {Thomas P.} and Shrif Costandi and Walega, {David R.} and Gerges Azer and Hayek, {Salim M.} and Zhen Wang and Eldrige, {Jason S.} and Wenchun Qu and Rosenow, {Joshua M.} and Falowski, {Steven M.} and Neuman, {Stephanie A.} and Moeschler, {Susan M.} and Catherine Wassef and Christopher Kim and Tariq Niazi and Taher Saifullah and Brian Yee and Chong Kim and Oryhan, {Christine L.} and Warren, {Daniel T.} and Imanuel Lerman and Ruben Mora and Michael Hanes and Thomas Simopoulos and Sanjiv Sharma and Chris Gilligan and Warren Grace and Timothy Ade and Mekhail, {Nagy A.} and Hunter, {John P.} and Daniel Choi and Choi, {Deborah Y.}",

note = "Publisher Copyright: {\textcopyright} 2017 International Neuromodulation Society",

year = "2017",

doi = "10.1111/ner.12636",

language = "English (US)",

volume = "20",

pages = "553--557",

journal = "Neuromodulation",

issn = "1094-7159",

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Bendel, MA, O'Brien, T, Hoelzer, BC, Deer, TR, Pittelkow, TP, Costandi, S, Walega, DR, Azer, G, Hayek, SM, Wang, Z, Eldrige, JS, Qu, W, Rosenow, JM, Falowski, SM, Neuman, SA, Moeschler, SM, Wassef, C, Kim, C, Niazi, T, Saifullah, T, Yee, B, Kim, C, Oryhan, CL, Warren, DT, Lerman, I, Mora, R, Hanes, M, Simopoulos, T, Sharma, S, Gilligan, C, Grace, W, Ade, T, Mekhail, NA, Hunter, JP, Choi, D & Choi, DY 2017, 'Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants', Neuromodulation, vol. 20, no. 6, pp. 553-557. https://doi.org/10.1111/ner.12636

TY - JOUR

T1 - Spinal Cord Stimulator Related Infections

T2 - Findings From a Multicenter Retrospective Analysis of 2737 Implants

AU - Bendel, Markus A.

AU - O'Brien, Travis

AU - Hoelzer, Bryan C.

AU - Deer, Timothy R.

AU - Pittelkow, Thomas P.

AU - Costandi, Shrif

AU - Walega, David R.

AU - Azer, Gerges

AU - Hayek, Salim M.

AU - Wang, Zhen

AU - Eldrige, Jason S.

AU - Qu, Wenchun

AU - Rosenow, Joshua M.

AU - Falowski, Steven M.

AU - Neuman, Stephanie A.

AU - Moeschler, Susan M.

AU - Wassef, Catherine

AU - Kim, Christopher

AU - Niazi, Tariq

AU - Saifullah, Taher

AU - Yee, Brian

AU - Kim, Chong

AU - Oryhan, Christine L.

AU - Warren, Daniel T.

AU - Lerman, Imanuel

AU - Mora, Ruben

AU - Hanes, Michael

AU - Simopoulos, Thomas

AU - Sharma, Sanjiv

AU - Gilligan, Chris

AU - Grace, Warren

AU - Ade, Timothy

AU - Mekhail, Nagy A.

AU - Hunter, John P.

AU - Choi, Daniel

AU - Choi, Deborah Y.

PY - 2017

Y1 - 2017

N2 - Introduction: Surgical site infection is a potential complication of spinal cord stimulator (SCS) implantation. Current understanding of the epidemiology, diagnosis, and treatment of these infections is based largely on small clinical studies, many of which are outdated. Evidence-based guidelines for management of SCS-related infections thus rely instead on expert opinion, case reports, and case series. In this study, we aim to provide a large scale retrospective study of infection management techniques specifically for SCS implantation. Methods: A multicenter retrospective study of SCS implants performed over a seven-year period at 11 unique academic and non-academic institutions in the United States. All infections and related complications in this cohort were analyzed. Results: Within our study of 2737 SCS implant procedures, we identified all procedures complicated by infection (2.45%). Localized incisional pain and wound erythema were the most common presenting signs. Laboratory studies were performed in the majority of patients, but an imaging study was performed in less than half of these patients. The most common causative organism was Staphylococcus aureus and the IPG pocket was the most common site of an SCS-related infection. Explantation was ultimately performed in 52 of the 67 patients (77.6%). Non-explantation salvage therapy was attempted in 24 patients and was successful in resolving the infection in 15 patients without removal of SCS hardware components. Discussion: This study provides current data regarding SCS related infections, including incidence, diagnosis, and treatment.

AB - Introduction: Surgical site infection is a potential complication of spinal cord stimulator (SCS) implantation. Current understanding of the epidemiology, diagnosis, and treatment of these infections is based largely on small clinical studies, many of which are outdated. Evidence-based guidelines for management of SCS-related infections thus rely instead on expert opinion, case reports, and case series. In this study, we aim to provide a large scale retrospective study of infection management techniques specifically for SCS implantation. Methods: A multicenter retrospective study of SCS implants performed over a seven-year period at 11 unique academic and non-academic institutions in the United States. All infections and related complications in this cohort were analyzed. Results: Within our study of 2737 SCS implant procedures, we identified all procedures complicated by infection (2.45%). Localized incisional pain and wound erythema were the most common presenting signs. Laboratory studies were performed in the majority of patients, but an imaging study was performed in less than half of these patients. The most common causative organism was Staphylococcus aureus and the IPG pocket was the most common site of an SCS-related infection. Explantation was ultimately performed in 52 of the 67 patients (77.6%). Non-explantation salvage therapy was attempted in 24 patients and was successful in resolving the infection in 15 patients without removal of SCS hardware components. Discussion: This study provides current data regarding SCS related infections, including incidence, diagnosis, and treatment.

KW - Complication

KW - infection

KW - spinal cord stimulation

KW - treatment

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UR - http://www.scopus.com/inward/citedby.url?scp=85030325797&partnerID=8YFLogxK

U2 - 10.1111/ner.12636

DO - 10.1111/ner.12636

M3 - Article

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SN - 1094-7159

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JO - Neuromodulation

JF - Neuromodulation

IS - 6

ER -

Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants

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